HIV Risk Behaviors and the Use of Geosocial Networking Dating Apps among Men Who have Sex with Men and Transgender Women in Lima, Peru: a Cross-Sectional Study

Geosocial networking dating apps (GSN apps) are an increasingly widespread technology used by populations throughout the world to facilitate sexual encounters. Studies from a variety of settings suggest a possible association between GSN app use and HIV risk behaviors, including among sexual and gender minority populations such as men who have sex with men (MSM) and transgender women (TW). However, it remains unclear to what extent GSN apps play a causal role. We explored the relationship between GSN app use and sexual risk behaviors among MSM and TW in Lima, Peru by analyzing data from a multi-site cross-sectional survey assessing both general and partner-specific sexual behaviors. We performed bivariate analysis to estimate the association of GSN app use with different individual and partner-specific factors, then fit multivariable regression models adjusting for age and education. Among 741 total participants (698 MSM, 43 TW), 64% met at least one sex partner in the prior three months using a GSN app. GSN app users were significantly more likely to report engaging in HIV risk behaviors in general, including condomless receptive anal sex, group sex, transactional sex, and sex under the influence of alcohol or drugs. Having condomless anal sex with a given partner was not associated with meeting that partner via GSN app. These findings highlight GSN app users as a particularly vulnerable subpopulation among MSM and TW in Lima. GSN apps could provide a useful vehicle for targeted HIV prevention efforts for priority populations in Peru.

Influences affecting decision-making regarding use of pre-exposure prophylaxis among black men who have sex with men in the USA: a systematic review and meta-synthesis

AIM

To systematically identify, evaluate, and synthesise qualitative research examining positive and negative influences affecting decision-making behaviour among black men who have sex with men (BMSM) in the USA regarding use of pre-exposure prophylaxis (PrEP).

BACKGROUND

Used correctly, PrEP is highly efficacious in preventing HIV infection and is available via healthcare services throughout the USA. BMSM are a key target population for HIV prevention services, however their engagement with these services is low. With potential barriers to access ranging from systemic to personal, a phenomenological perspective on the influences affecting individuals' decision-making is essential, helping to better understand the needs of this target population and guide development and delivery of more effective future policy and intervention services.

DESIGN

Qualitative meta-synthesis with meta-aggregation.

DATA SOURCES

The electronic databases Medline, CINAHL, APA PsycInfo, Embase and Ovid Emcare were comprehensively searched from inception to 21 January 2022.

REVIEW METHODS

Systematic identification, quality assessment and synthesis of existing qualitative research according to protocols of meta-aggregation. This included identifying salient study findings and corroborating illustrations from the data, sorting like findings into descriptive themed categories and developing transformative synthesised statements from aggregate appraisal of category findings.

RESULTS

Seventeen studies met the inclusion criteria and were assessed to be of acceptable quality. Synthesis of study data yielded 30 categories grouped under five themes: Stigma, Discrimination, Mistrust, PrEP positivity and PrEP negativity. Twelve synthesised statements were produced to provide a summary of the results and suggest improvements to the delivery of future PrEP services and interventions.

CONCLUSION

A more targeted approach focused on advocacy and ambassadorship outside of clinical settings may be more influential in positive decision-making regarding use of PrEP in BMSM populations than relying on traditional outreach methods via institutions and their representatives where stigma, mistrust and structural inequalities perpetuate.

Modelling the impact of vaccination and sexual behaviour adaptations on mpox cases in the USA during the 2022 outbreak

BACKGROUND

The 2022 mpox outbreak has infected over 30 000 people in the USA, with cases declining since mid-August. Infections were commonly associated with sexual contact between men. Interventions to mitigate the outbreak included vaccination and a reduction in sexual partnerships. Understanding the contributions of these interventions to decreasing cases can inform future public health efforts.

METHODS

We fit a dynamic network transmission model to mpox cases reported by Washington DC through 10 January 2023. This model incorporated both vaccine administration data and reported reductions in sexual partner acquisition by gay, bisexual or other men who have sex with men (MSM). The model output consisted of daily cases over time with or without vaccination and/or behavioural adaptation.

RESULTS

We found that initial declines in cases were likely caused by behavioural adaptations. One year into the outbreak, vaccination and behavioural adaptation together prevented an estimated 84% (IQR 67% to 91%) of cases. Vaccination alone averted 79% (IQR 64% to 88%) of cases and behavioural adaptation alone averted 25% (IQR 10% to 42%) of cases. We further found that in the absence of vaccination, behavioural adaptation would have reduced the number of cases, but would have prolonged the outbreak.

CONCLUSIONS

We found that initial declines in cases were likely caused by behavioural adaptation, but vaccination averted more cases overall and was key to hastening outbreak conclusion. Overall, this indicates that outreach to encourage individuals to protect themselves from infection was vital in the early stages of the mpox outbreak, but that combination with a robust vaccination programme hastened outbreak conclusion.

Investigating the impact of condomless vaginal intercourse and lubricant use on the vaginal metabolome: a pre-post observational study

OBJECTIVE

The vaginal metabolome is a significant factor in the vaginal microenvironment, and data are emerging on its independent role in urogenital health. Condomless vaginal intercourse and personal lubricant use are common practices that may affect the vaginal metabolome. The aim of the present study is to describe the associations between condomless intercourse and lubricant use on the vaginal metabolome.

METHODS

This study used archived mid-vaginal swabs from a 10-week observational cohort of reproductive age women who self-collected samples and recorded behavioural diaries daily. Cases and controls were defined as participants who self-reported condomless vaginal intercourse with or without lubricant use, respectively. Samples were drawn prior to and following condomless vaginal intercourse. Twenty-two case participants were race/ethnicity matched to 22 control participants. Mid-vaginal swabs were subjected to 16S rRNA gene amplicon sequencing and untargeted ultrahigh performance liquid chromatography tandem mass spectroscopy metabolomics. Bayesian mixed-effects regression (unadjusted and adjusted for the vaginal microbiota) was used to evaluate differences in metabolite concentration associated with vaginal intercourse and lubricant use.

RESULTS

Both condomless penile-vaginal intercourse and lubricant use were independently associated with higher (up to 8.3-fold) concentrations of metabolites indicative of epithelial damage (eg, sarcosine) and many host-produced antioxidants. Lubricant use was significantly associated with increases in lipids related to cellular damage, host-produced sphingolipids (antimicrobials), antioxidants and salicylate, a cooling agent common to lubricants, in a study design which controls for the independent effect of intercourse. Metabolites involved in oxidative stress and salicylate were strongly correlated with several molecular bacterial vaginosis-associated bacteria.

CONCLUSIONS

This study provides important foundational data on how condomless vaginal-penile intercourse and lubricant use affect the vaginal metabolome and may affect the protective mechanisms in the vaginal microenvironment.

Predictors of starting and stopping chemsex in men who have sex with men in England: findings from the AURAH2 prospective study

BACKGROUND

Chemsex (the use of psychoactive drugs in sexual contexts) has been associated with HIV acquisition and other STIs, so there is benefit in identifying those most likely to start chemsex to offer risk reduction interventions such as pre-exposure prophylaxis (PrEP). To date, there have been no data from a longitudinal study analysing factors most associated with starting and stopping chemsex.

METHODS

The prospective cohort study, Attitudes to and Understanding Risk of Acquisition of HIV over Time (AURAH2), collected 4 monthly and annual online questionnaire data from men who have sex with men (MSM) from 2015 to 2018. We investigate the association of sociodemographic factors, sexual behaviours and drug use with starting and stopping chemsex among 622 men who completed at least one follow-up questionnaire. Poisson models with generalised estimating equations were used to produce risk ratios (RRs) accounting for multiple starting or stopping episodes from the same individual. Multivariable analysis was adjusted for age group, ethnicity, sexual identity and university education.

FINDINGS

In the multivariable analysis, the under 40 age group was significantly more likely to start chemsex by the next assessment (RR 1.79, 95% CI 1.12 to 2.86). Other factors which showed significant association with starting chemsex were unemployment (RR 2.10, 95% CI 1.02 to 4.35), smoking (RR 2.49, 95% CI 1.63 to 3.79), recent condomless sex (CLS), recent STI and postexposure prophylaxis (PEP) use in the past year (RR 2.10, 95% CI 1.33 to 3.30). Age over 40 (RR 0.71, 95% CI 0.51 to 0.99), CLS, and use of PEP (RR 0.64, 95% CI 0.47 to 0.86) and PrEP (RR 0.47, 95% CI 0.29 to 0.78) were associated with lower likelihood of stopping chemsex by the next assessment.

INTERPRETATION

Knowledge of these results allows us to identify men most likely to start chemsex, thus providing an opportunity for sexual health services to intervene with a package of risk mitigation measures, especially PrEP use.

Towards the prevention of sexually transmitted infections (STIs): Healthcare-seeking behaviour of women with STIs or STI symptoms in sub-Saharan Africa

OBJECTIVE

Sexually transmitted infections (STIs) constitute major public health problems because of their prevalence and contribution to mortality and morbidity worldwide. Healthcare seeking for STIs plays a significant role in the global prevention of STIs. We examined the prevalence and factors associated with healthcare seeking for STIs or STI symptoms among women in sub-Saharan Africa (SSA).

METHODS

Data on 38 394 women of reproductive age from the most recent Demographic and Health Surveys of 28 countries in SSA were analysed. Percentages were used to summarise the prevalence of healthcare seeking for STIs or STIs symptoms. The factors associated with healthcare seeking for STIs or STI symptoms were examined using multilevel binary logistic regression analysis. We presented the results using adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

RESULTS

Overall, the proportion of women with STIs or STI symptoms who sought healthcare was 66.1%, with the highest and lowest proportion found in Liberia (85.6%) and Ethiopia (37.9%) respectively. The likelihood of seeking healthcare for STIs or STI symptoms increased with increasing wealth quintile and level of education. Working women, older women, cohabiting women, women with comprehensive HIV/AIDS knowledge, women exposed to mass media, those who had no barrier to healthcare access, and those covered by health insurance had greater odds of seeking treatment for STIs or STI symptoms. On the contrary, the odds of seeking treatment for STIs or STI symptoms was lower among married women and women who lived in rural areas.

CONCLUSION

The findings of the study call for strengthening of policies, programmes, and interventions geared towards improving thehealthcare-seeking behaviour of women with STIs, taking into consideration the factors identified in this study.

Understanding sexual transmission dynamics and transmission contexts of monkeypox virus: a mixed-methods study of the early outbreak in Belgium (May-June 2022)

OBJECTIVE

The available epidemiological and clinical evidence from the currently ongoing monkeypox (MPX) outbreak in non-endemic areas suggests an important factor of sexual transmission. However, limited information on the behaviour and experiences of individuals with an MPX infection has to date been provided. We aimed to describe the initial phase of the MPX outbreak in Belgium, and to provide a more in-depth description of sexual behaviour and transmission contexts.

METHODS

We used routine national surveillance data of 139 confirmed MPX cases with date of symptom onset until 19 June 2022, complemented with 12 semistructured interviews conducted with a subsample of these cases.

RESULTS

Sexualised environments, including large festivals and cruising venues for gay men, were the suspected exposure setting for the majority of the cases in the early outbreak phase. In-depth narratives of sexual behaviour support the hypothesis of MPX transmission through close physical contact during sex. Despite awareness of the ongoing MPX outbreak, low self-perceived risk of MPX acquisition and confusing initial signs and symptoms for other STIs or skin conditions delayed early detection of an MPX infection. In addition, we describe relevant contextual factors beyond individual behaviour, related to sexual networks, interpersonal interactions and health systems. Some of these factors may complicate early MPX detection and control efforts.

CONCLUSION

Our results highlight the role of sexual contact and networks in the transmission of MPX during the early phase of the outbreak in Belgium. Risk communication messages should consistently and transparently state the predominant sexual transmission potential of MPX virus, and prevention and control measures must be adapted to reflect multilevel factors contributing to MPX transmission risk.

Changes in male sexuality after urologic cancer: a narrative review

OBJECTIVE

To describe the most common sexual problems and changes experienced by male urological cancer survivors, focusing on evidence-based practices for assessment and intervention.

MATERIALS AND METHODS

We search the PubMed, Embase, and SciELO databases between 1994 and 2022, using the following key words: "urological cancer", "urological malignances", "genitourinary cancer", "male sexual health", and "male sexual dysfunction".

RESULTS

This narrative review provides an overview of the current literature involving the impact of diagnosis and treatment of urological cancers on male sexual function. Male "genital" or "reproductive" tumors, such as prostate, penile, and testicular tumors, clearly appear to affect sexual function. However, tumors that do not involve genital parts of the body, such as the bladder and kidney, can also affect male sexual function.

CONCLUSION

Male sexual dysfunction is very common after urologic cancer diagnosis and treatment. Changes in body image and anatomical damage can be associated with impaired masculinity and sexual function, especially after prostate, penile or testicular cancer treatment. Moreover, anxiety, depression, and fear of recurrence have an impact on quality of life and sexual function regardless of the cancer location. Therefore, patients need be counseled about the likely changes in sexual function before treatment of any urological cancer.

Sex with animals among men attended in referral centers for sexually transmitted infections in northeast Brazil: prevalence, associated factors and behavioral aspects

PURPOSE

Our objective was to investigate the prevalence of SWA, associated factors, relationship with STIs, and behavioral aspects in men attended at Referral Centers for STIs and acquired immunodeficiency syndrome (AIDS)/CR-STI/AIDS in northeast Brazil.

MATERIALS AND METHODS

In this cross-sectional study, a questionnaire with sociodemographic, clinical, sexual and SWA practices information was applied to 400 men attended at two CR-STI/AIDS in Northeast Brazil on the years of 2018 and 2019. Clinical and laboratory diagnoses of STIs were confirmed in medical records. Logistic regression models were performed to identify the independent predictors for SWA.

RESULTS

The prevalence of SWA over total samples was 15.00%. Of the participants, 239 (59.75%) of the participants were diagnosed with STIs, and of these 37 (15.48%) reported SWA. Most men practiced SWA in adolescence, being the last episode more than 20 years ago, usually with asinine and mules, in vaginal route and without a condom. SWA practitioners have higher percentages of occurrence of some viral STIs. SWA was associated with increasing age, history of residence in a rural area with remained over 12 years, married or widowed/separated, heterosexuals, with less than 7 years of study, Catholics, with hepatitis B, former user of alcoholic beverages and smokers, with a history of STI and intercourse with sex workers.

CONCLUSION

SWA practices increase STIs vulnerability. The association between hepatitis B and SWA highlights the importance of educational campaigns and conclusive studies on the topic.

Association of high-risk sexual behaviours with sexually transmitted infections among men who have sex with men living with HIV

OBJECTIVES

To explore different sexual behaviours as risk factors for STI among men who have sex with men (MSM) living with HIV.

METHODS

This is a cross-sectional study on MSM living with HIV followed at the Infectious Diseases Unit of San Raffaele Hospital, Milan, with at least one diagnosis of gonorrhoea, syphilis, chlamydia or anal human papilloma virus (HPV), between July 2016 and February 2021. We conducted a survey on high-risk sexual behaviours with regard to (1) mean number of partners per month, (2) estimated percentage of condom use and (3) most frequent type of sexual intercourse during 2016-2021. Data on these variables were grouped as follows: (1a) ≤5 vs >5, (1b) >10 vs ≤10, (2a) 0% vs >0%, (2b) ≤50% vs >50%, (2c) 100% vs <100%, (3a) ≥50% vs <50% receptive, (3b) 100% vs <100% insertive, and (3c) 100% vs <100% receptive. A high-risk group was defined as >5 partners, <100% use of condom and ≥50% receptive intercourse. Univariate logistic regressions were applied to assess the association between sexual behaviours and the risk of each STI.

RESULTS

Out of 1051 MSM with at least one STI diagnosis, 580 (55%) answered the survey. The risk of chlamydia was lower among individuals with ≤5 partners (≤5 partners vs >5 partners: OR=0.43, 95% CI 0.28 to 0.66, p=0.001) and among those using condoms more frequently (≤50% use of condom vs >50% use of condom: OR=1.55, 95% CI 1.06 to 2.27, p=0.025; 100% vs <100%: OR=0.35, 95% CI 0.20 to 0.59, p=0.001). Individuals using condoms more frequently also had lower risk of gonorrhoea (100% use of condom vs <100% use of condom: OR=0.37, 95% CI 0.17 to 0.79, p=0.011). The risks of chlamydia (OR=3.07, 95% CI 1.92 to 4.90, p<0.001) and gonorrhoea (OR=2.05, 95% CI 1.12 to 3.75, p=0.020) were higher among individuals belonging to the high-risk group.

CONCLUSIONS

Chlamydia and gonorrhoea are more likely associated with high-risk sexual behaviours than syphilis and anal HPV among MSM living with HIV.

Crystal methamphetamine use and bacterial sexually transmitted infections (STIs) among gay, bisexual and other sexual minority men in Canada

OBJECTIVE

While crystal methamphetamine use by gay, bisexual, and other men who have sex with men (GBM) is associated with increased risk for sexually transmitted infection (STI) transmission, less is understood about the causal pathways between crystal methamphetamine use and STIs. We examined whether the association between greater crystal methamphetamine risk and prevalent bacterial STI diagnosis among GBM was mediated by two types of attitudinal variables: attitudes toward condoms, and sexual escape motives, defined as the use of substances to escape self-awareness during sex, and by sexual behaviors.

METHODS

We used computer-assisted self-interview questionnaires from 2449 sexually active GBM (18% living with HIV; median age = 33, interquartile range, 27-45) recruited via respondent-driven sampling in Vancouver, Toronto, and Montreal, Canada. Using the baseline data from the Engage cohort study, we fit a series of structural mediation models of the associations between greater crystal methamphetamine risk and bacterial STI (syphilis, gonorrhea, and chlamydia) diagnosis. We estimated indirect paths from greater crystal methamphetamine risk, attitudes toward condoms, sexual escape motives, and sexual risk behaviors, adjusting for self-reported demographic variables.

RESULTS

In the mediated model, the direct association between greater crystal methamphetamine risk and bacterial STI diagnosis was non-significant; however, five indirect paths were significant. Greater crystal methamphetamine risk was associated with bacterial STIs via condom use attitudes and escape motives, which in turn were associated with number of male anal sex partners, condomless anal sex, and oral sex.

DISCUSSION

Public health and counselling interventions for GBM who use crystal methamphetamine and who are at higher risk for STIs should target evidence-based causal paths that consider sexual attitudes and sexual practices.

Sexual Health During COVID-19: A Scoping Review

INTRODUCTION

The COVID-19 pandemic impacted profoundly on the wellbeing and social interactions of the world population, and all dimensions of sexual health were potentially affected by globally implemented preventive measures.

OBJECTIVES

The scoping review aimed to compile existing research investigating possible effects of COVID-19 lockdowns on adult sexual health, that is, sexual behavior, functioning, and satisfaction. Further, studies on the interplay between mental health and sexual well-being during the pandemic were reviewed.

METHODS

The review was conducted in accordance with guidelines established by the Joanna Briggs Institute and the Extension for Scoping Reviews (PRISMA-ScR) Checklist. On October 11-12, 2021, PubMed, Embase, PsycInfo, Cinahl, Cochrane, Sociological Abstracts and Scopus were systematically searched for relevant peer-reviewed papers employing quantitative methodology. Additionally, unpublished ("grey") research studies on the subject were retrieved. The screening, data extraction, and analysis of evidence were conducted by 4 independent reviewers using an iterative approach.

RESULTS

Based on 107 studies included, the scoping review showed that the pandemic had had a wide impact on all dimensions of sexual health. Except for solo sex activities, mainly negative COVID-19 implications were identified, although findings were, in sum, characterized by complexity and unpredictability. Thus, sexual behavior, functioning, and satisfaction during the pandemic appeared to be mitigated by a broad range of sociodemographic and contextual factors. Finally, sexual health seemed deeply entwined with overall mental health.

CONCLUSION

The scoping review revealed a broad range of COVID-19-related effects on sexual health, including an overall decline in partnered sex and a concurrent increase in solo sex activities. It also emphasized a need for future research to shed light on possible long-term consequences of the pandemic in various population groups and on all aspects of sexual health. Toldam NE, Graugaard C, Meyer R, et al. Sexual Health During COVID-19: A Scoping Review. Sex Med Rev 2022;10:714-753.

Online Sexual Activity among Iranian Clients with Borderline Personality Disorder and Its Correlation with Severity of Symptoms

Objective: Clients with borderline personality disorder (BPD) often engage in high-risk sexual behaviors. Online sexual platforms convey abusive and harmful themes, especially for this group of sexually impulsive patients. We hypothesized a correlation between their online sexual activities and the severity of BPD symptoms. Method : Fifty clients with BPD who were referred to Iran psychiatric hospital and Tehran Psychiatric Institute in 2020 participated in this research. The Borderline Evaluation of Severity over Time (BEST) questionnaire was used to assess the severity of BPD symptoms, and the Internet Sex Screening Test (ISST) was used to evaluate online sexual behaviors. A psychiatric interview considered substance abuse and other confounding factors. Results: The mean ISST and BEST scores were 7.82 ± 5.74 and 41.7 ± 12.5, respectively. There was a positive and significant correlation between the severity of BPD symptoms and online sexual activities (P < 0.001, r = 0.480). There was also a significant relationship between online sexual activities and a history of substance abuse (P = 0.003, F = 25.06). Conclusion: Online sexual activity can harm clients with BPD who are more vulnerable to high-risk sexual behaviors. More severe borderline personality traits were associated with more online sexual activity, which underlines the importance of providing education about and managing such activities in clients with BPD.

Sexual behaviours and sexual health among middle-aged and older adults in Britain

OBJECTIVES

Population-representative studies of the sexual health of middle-aged and older adults are lacking in ageing societies. This study aimed to identify latent patterns of sexual behaviours and health of people aged 45-74 years.

METHODS

We conducted a latent class analysis of the National Attitudes and Sexual Lifestyles Survey (Natsal-3), a nationally representative survey conducted in Britain in 2011.

RESULTS

Of the 5260 respondents aged 45-74 years, 48.86% of men and 44.91% of women belonged to the Content Caseys class who reported good sexual health. The Infrequent Indigos (30.94% of men, 44.38% of women) were characterised by a lack of sexual activity, reported some dissatisfaction, and were more likely to have a disability. The Low-Functioning Lees (11.65% of men, 8.41% of women) reported some more disability and had issues with sexual functioning and higher levels of distress. The Multiple-Partnered Morgans (8.62% of men, 2.30% of women) were characterised by a greater number of sexual partners and several risk behaviours.

CONCLUSIONS

The use of these four classes can aid in improved targeting of tailored sexual health services to improve sexual function, sexual satisfaction, reduce distress and risky behaviours among middle-aged and older adults. These services should be inclusive of the disabled community.

Characterization of Female Sexual Dysfunction Associated with Spinal Pathology and Surgery

INTRODUCTION

Studies demonstrate the connection between adverse sexual function and medical conditions such as diabetes and heart disease. However, in the areas of spinal and spinal cord pathologies that require surgical interventions, there are scant data.

OBJECTIVES

We undertook a narrative review to synthesize what is known on the topic, raise awareness, and call for action.

METHODS

PubMed and Google Scholar identified case reports and primary studies evaluating female sexual dysfunction associated with spinal pathology as well as surgical intervention success were reviewed to contextualize and characterize female sexual dysfunction.

RESULTS

Available case reports and primary studies suggest that female sexual dysfunction can result from traumatic spinal etiologies, malignant tumors, and benign tumors with and without bony involvement. Although identified as a key preoperative predictor in maintenance or improvement of neurologic status, sexuality is rarely addressed in the neurosurgical care plan. In spinal stenosis and degenerative spine disease, over half of patients report pain with sexual activity. Importantly, while pain can hinder sexual activity in females, there are other sexual issues, including desire and subjective arousal, lubrication, orgasm, and satisfaction that are usually not explored. Studies show the impact of spinal pathologies on frequency of sexual intercourse, hypoesthesia, anorgasmia, and depression. Surgical intervention of spinal pathologies has been cited to improve back pain however other types of sexual dysfunction usually fails to improve after surgical intervention.

CONCLUSIONS

The lack of high-quality research with adequate numbers of female participants that appropriately characterizes the nuances of female sexual dysfunction across various spinal pathologies, with post-surgical intervention analysis and consideration of surgical approach, necessitates consideration for future study. A pre-op and post-op sexual history in all woman undergoing spinal surgery should be a standard of care. Moscicki P, Bachmann GA. Characterization of Female Sexual Dysfunction Associated with Spinal Pathology and Surgery. Sex Med Rev 2021;XX:XXX-XXX.

Orgasm Rating Scale and Bodily Sensations of Orgasm Scale: Validation for Use With Pre, Peri, and Post-Menopausal Women

BACKGROUND

Orgasm, particularly in older women, remains a poorly understood aspect of female sexual response partly because of a lack of validated self-report measures.

AIM

To evaluate the Orgasm Rating Scale (ORS) and Bodily Sensations of Orgasm Scale (BSOS) for use with pre, peri, and post-menopausal women and between solitary and partnered orgasm contexts.

METHODS

Participants (solitary context, 252 pre, 139 peri, 190 post; partnered context, 229 pre, 136 peri, and 194 post-menopausal women, aged 18-82 years) were asked to complete an online questionnaire based on most recent solitary and partnered orgasm. Principal components analysis with Varimax rotation summarized the data into interpretable baseline models for all groups. Multi-Group Confirmatory Factor Analysis tested for multi-group measurement invariance. Adjustments to the models were made, and final model structures were presented.

MAIN OUTCOME MEASURES

ORS and BSOS measuring solitary and/or masturbation and partnered orgasm.

RESULTS

For the ORS, 10 factor solutions were preferred, explaining 81% (pre), 80% (peri), and 81% (post) of the variance for the solitary and 83% (pre), 86% (peri), and 84% (post) of the variance for the partnered context. Factors included pleasurable satisfaction, ecstasy, emotional intimacy, relaxation, building sensations, flooding sensations, flushing sensations, shooting sensations, throbbing sensations, and general spasms. For the BSOS, 3 factor solutions were preferred, explaining 55% (pre), 60% (peri), and 56% (post) of the variance for the solitary and 56% (pre), 61% (peri), and 60% (post) of the variance for the partnered context. Factors included extragenital sensations, genital sensations and spasms, and nociceptive sensations and sweating responses. Divergent validity was observed (solitary r = -.04; partnered r = -.11) and configural, metric and scalar invariance for the solitary and partnered versions of the ORS and BSOS were found, suggesting the measures were interpreted similarly by all women.

CLINICAL IMPLICATIONS

With valid measurement tools, women's varying orgasm experiences can be investigated more systematically and compared to address gaps and conflicts in the existing literature. Ultimately, these additions may assist with improved interventions for women who are unsatisfied with their orgasm experiences.

STRENGTHS AND LIMITATIONS

Strengths include gaining the ability to compare age and menopausal status groups using empirically validated measures of orgasm experience. Limitations include cross-sectional design and lack of test-retest reliability measurement.

CONCLUSION

The ORS and BSOS are supported for use with women across adulthood in solitary and partnered orgasm contexts and can be used concurrently to provide a comprehensive assessment. Webb AE, Reissing ED, Huta V. Orgasm Rating Scale and Bodily Sensations of Orgasm Scale: Validation for Use With Pre, Peri, and Post-Menopausal Women. J Sex Med 2022;19:1156-1172.

Pre-exposure prophylaxis and bacterial sexually transmitted infections (STIs) among gay and bisexual men

OBJECTIVES

While pre-exposure prophylaxis (PrEP) prevents HIV acquisition among gay, bisexual and other men who have sex with men (GBM), PrEP-using GBM may be more likely to engage in sexual behaviours associated with bacterial STIs. We examined associations between PrEP use, condomless anal sex (CAS), number of anal sex partners, oral sex and bacterial STI diagnoses among GBM living in Canada's three largest cities.

METHODS

Among HIV-negative/unknown-status GBM in the baseline of the Engage cohort study, we fit a structural equation model of the associations between any PrEP use, sexual behaviours and bacterial STI diagnosis. We estimated direct and indirect paths between PrEP use and STI via CAS, number of anal sex partners and oral sex.

RESULTS

The sample included 2007 HIV-negative/unknown status GBM in Montreal, Toronto and Vancouver. There was a significant direct association between PrEP use and current STI diagnosis (β=0.181; 95% CI: 0.112 to 0.247; p<0.001), CAS (β=0.275; 95% CI: 0.189 to 0.361; p<0.001) and number of anal sex partners (β=0.193; 95% CI: 0.161 to 0.225; p<0.001). In the mediated model, the direct association between PrEP use and STIs was non-significant. However, the indirect paths from PrEP to CAS to STIs (β=0.064; 95% CI: 0.025 to 0.120; p=0.008), and from PrEP to greater number of anal sex partners to CAS to STIs were significant (β=0.059; 95% CI: 0.024 to 0.108; p=0.007).

CONCLUSIONS

Our study adds to the growing awareness that PrEP use among GBM may be associated with bacterial STIs because PrEP users have more anal sex partners and are more likely to engage in CAS. The results underscore the importance of providing effective STI counselling and regular testing to PrEP users, adapting PrEP care and related STI testing to individual needs, and the need for effective prevention strategies for bacterial STIs.

Variation in the sexual behavior and blood count parameters induced by sleep deprivation in male rats

BACKGROUND

Sleep is a fundamental biological requirement, and lack of sleep has increasingly been recognized to cause metabolic consequences and adversely affect immune function. Recent articles have pointed to how sleep and sexual functions may be interlinked, involving inflammation, vascular alterations, tissue damage, and endothelial dysfunction.

OBJECTIVES

We examined the effect of paradoxical sleep deprivation (PSD) on sexual behavior and hemogram parameters in male rats. In addition, we also explored whether 7 days of recovery sleep is sufficient to offset these detriments.

MATERIALS AND METHODS

 Male rats were given sexual experience through training. At the 5th test, the sexually vigorous males were randomly separated into 3 experimental groups: PSD (rats submitted to 96 hours of PSD, n = 6), RS (recovery sleep 7 days after PSD, n = 6), and control (n = 10). We evaluated the sexual behaviors of three groups. Blood samples were collected to analysis hemogram parameters.

RESULTS

In this study, we recognized that repeated copulatory tests can lead to changes in sexual behavior over time. We found that 96 hours of acute sleep deprivation impaired the sexual behavior of male rats. Our results demonstrated that 96 hours of PSD also increased levels of white blood cell (WBC) subpopulations, in particular neutrophils. Recovery sleep after sleep deprivation has a certain reversal effect on WBC subgroups and impairment of sexual behavior, with some signs that not all levels were back to baseline even after 7 days of recovery.

CONCLUSION

In general, we found that 96 hours of PSD impaired the sexual behavior of male rats. Our results demonstrated that PSD can cause systemic inflammation by affecting WBC subpopulations, in particular neutrophils. 7 days of recovery sleep after sleep deprivation has a certain reversal effect to these impairments. This article is protected by copyright. All rights reserved.

Changes in Frequency and Patterns of Marital Sexual Activity During COVID-19: Evidence From Longitudinal Data Prior to, During and After Lockdown in Singapore

BACKGROUND

The literature suggests that the pandemic has affected sexual activity and sexual desire around the world, potentially due to increased levels of stress, movement restrictions under lockdown conditions, and changes in relationship quality.

AIM

To investigate changes in frequency and patterns of marital sexual activity and the role of potential factors underlying these changes, during and after COVID-19 lockdown.

METHODS

This longitudinal study followed 409 heterosexual married female participants who completed a baseline survey in April-July 2018 and biweekly online surveys over the next 14 weeks; an online survey in May 2020 during the lockdown in Singapore; and an online survey in June 2020 after the lockdown was lifted. Participants were recruited in 2018 using street intercept and screened for inclusion and exclusion criteria. Logistic fixed-effects models were used to test for changes in frequency and patterns of marital sexual activity and assess underlying factors. Pseudo-design-based sample weights were applied.

OUTCOMES

The 2018 in-person baseline survey collected information on demographic characteristics and ideal frequency of marital sex, while follow-up online questionnaires in May-June 2020 included items on exact dates of marital sexual activity of previous weeks; stress and fatigue levels; both spouses' stay-at-home statuses during lockdown; and marital satisfaction.

RESULTS

409 heterosexual married women were included in this study. Compared to pre-pandemic levels, the proportion of participants not having marital sex within a week remained stable while weekly sexual frequency increased, with more evenly distributed sexual activity on weekdays and weekends. Stress, fatigue, and marital satisfaction levels predicted probability of non-activity and sexual frequency.

CLINICAL TRANSLATION

The increase in weekly sexual frequency has implications for sexual and reproductive health, including sexual satisfaction and prevalence of infertility and low birth weight associated with waiting time to pregnancy.

STRENGTHS & LIMITATIONS

The longitudinal nature of the dataset provides unique insights into differences in frequency of marital sexual activity during compared to before the pandemic. Unlike previous studies, detailed data on exact dates of sexual activity allow for detection of differences in sexual activity by day of the week. However, dates of sexual activity were recorded retrospectively and may contain recall errors. Data were collected only from wives and hence dates of marital sexual activities were not cross-validated with husbands.

CONCLUSION

Results point to more active and flexible marital sex lives during the pandemic, with effects that persisted after the lockdown ended. Tan PL. Changes in Frequency and Patterns of Marital Sexual Activity During COVID-19: Evidence From Longitudinal Data Prior to, During and After Lockdown in Singapore. J Sex Med 2022;19:188-200.

"Postulating Penis: What Influences the Interest of Transmasculine Patients in Gender Affirming Penile Reconstruction Techniques?"

BACKGROUND

The limitations of metoidioplasty and phalloplasty have been reported as deterrents for transgender and other gender expansive individuals (T/GE) desiring gender affirming surgery, and thus penile transplantation, epithesis, and composite tissue engineering (CTE) are being explored as alternative interventions.

AIM

We aim to understand the acceptability of novel techniques and factors that may influence patient preferences in surgery to best treat this diverse population.

METHODS

Descriptions of metoidioplasty, phalloplasty, epithesis, CTE, and penile transplant were delivered via online survey from January 2020 to May 2020. Respondents provided ordinal ranking of interest in each intervention from 1 to 5, with 1 representing greatest personal interest. Demographics found to be significant on univariable analysis underwent multivariable ordinal logistic regression to determine independent predictors of interest.

OUTCOMES

Sexual orientation, gender, and age were independent predictors of interest in interventions.

RESULTS

There were 965 qualifying respondents. Gay respondents were less likely to be interested in epithesis (OR: 2.282; P = .001) compared to other sexual orientations. Straight individuals were the least likely to be interested in metoidioplasty (OR 3.251; P = .001), and most interested in penile transplantation (OR 0.382; P = .005) and phalloplasty (OR 0.288, P < .001) as potential interventions. Gay and queer respondents showed a significant interest in phalloplasty (Gay: OR 0.472; P = .004; Queer: OR 0.594; P = .017). Those who identify as men were more interested in phalloplasty (OR 0.552; P < .001) than those with differing gender identities. Older age was the only variable associated with a decreased interest in phalloplasty (OR 1.033; P = .001). No demographic analyzed was an independent predictor of interest in CTE.

CLINICAL IMPLICATIONS

A thorough understanding of patient gender identity, sexual orientation, and sexual behavior should be obtained during consultation for gender affirming penile reconstruction, as these factors influence patient preferences for surgical interventions.

STRENGTHS AND LIMITATIONS

This study used an anonymous online survey that was distributed through community channels and allowed for the collection of a high quantity of responses throughout the T/GE population that would otherwise be impossible through single-center or in-person means. The community-based methodology minimized barriers to honesty, such as courtesy bias. The survey was only available in English and respondents skewed young and White.

CONCLUSION

Despite previously reported concerns about the limitations of metoidioplasty, participants ranked it highly, along with CTE, in terms of personal interest, with sexual orientation, gender, and age independently influencing patient preferences, emphasizing their relevance in patient-surgeon consultations. A. Parker, G. Blasdel, C. Kloer et al. "Postulating Penis: What Influences the Interest of Transmasculine Patients in Gender Affirming Penile Reconstruction Techniques?". J Sex Med 2022;19:385-393.

Sexting and Behavioral Health in First-time Justice-Involved Adolescents

Objectives

We examined the prevalence of sexting, related motivations, demographics, and association with behavioral health problems among justice-involved adolescents.

Hypotheses

We hypothesized positive associations between sexting and sexual risk, substance use, delinquency, and mental health problems.

Methods

Participants were 307 community-supervised justice-involved adolescents with a first-time offense (Mage =14.50 years, 44.6% female) and their caregivers. Adolescents answered questions on technology use and sexting by sending, receiving, or forwarding sexually suggestive text messages and images (pictures or videos). They also completed measures of recent (past 4-month) sexual activity, unprotected sex, cigarette, alcohol, marijuana, and other drug use, and delinquency; current trauma symptoms, internalizing problems, and adaptive functioning.

Results

Prevalence of sexting were 37.7% (lifetime overall; 17.0% sent texts; 17.4% sent images) and 29.5% (past-year overall; 12.8% sent texts; 13.6% sent images). Sexts were commonly sent as presents to partners, in response to sexts received, or to have fun. "Sexters" were older than "non-sexters" and more likely to identify as lesbian, gay, bisexual, or questioning. Past-year sexting was significantly associated with recent sexual activity; unprotected sex; alcohol use and days of use; marijuana and other drug use; delinquency and variety of delinquent acts; and elevated trauma symptoms and internalizing problems.

Conclusions

Sexting is prevalent among adolescents with a first-time offense and co-occurs with multiple behavioral health needs. Intervention for this population may be informed by routinely assessing sexting in community settings. Familiarity with local reporting laws could help clinicians navigate the legal implications of sexting among adolescents with existing justice-system involvement.

Premature Ejaculation Among Internet Users Living in the Metropolitan Region of São Paulo, Brazil: A Cross-Sectional Comparison Between the Premature Ejaculation Diagnostic Tool (PEDT) and Patient-Reported Latency Time and Perception

Background

Premature ejaculation (PE) prevalence can vary according to different definitions, assessment methods and populational demographics and culture.

Aims

To investigate the differences between men classified as having “probable PE” (PEDT≥11), “possible PE” (PEDT = 9 or 10) or “no PE” (PEDT≤8) according to the Premature Ejaculation Diagnostic Tool (PEDT) criteria in regard to sociodemographic characteristics, and sexual and relational behavior. To assess the agreement of prevalence of PE according to 3 assessment methods: (i) the ejaculation latency time (ELT) according to the participant's memory; (ii) PEDT and (iii) a direct question about the self-perception of ejaculation as being normal, too early (premature) or retarded.

Methods

In this web-based cross-sectional study, men aged ≥ 18 years living in the metropolitan region of São Paulo, Brazil, responded anonymously to an online survey. We used multinomial regression to estimate the association between PE according PEDT criteria and other features and the kappa coefficient to estimate agreement between the assessment methods.

Outcomes

Association between PEDT-PE, sociodemographic characteristics and sexual and relational behaviors; agreement between PEDT, ELT and self-perception of PE.

Results

Obesity, trying to hold back ejaculation, short or nonexistent foreplay and age <30 years were associated with PEDT ≥11. Men who considered that latency was shorter for oral, anal and vaginal sex than for masturbation were more likely to have probable PE according to PEDT. Possible PE (PEDT scores 9/10) was associated with trying to hold back ejaculation and considering time for ejaculation shorter for vaginal sex. There was fair agreement between assessments (kappa 0.39; CI:0.28 –0.42; P < .001).

Conclusion

PE prevalence varies according to instruments and cut-offs used, with fair agreement between them. This finding shows that the methods evaluate different aspects of the EP syndrome and they must be combined to allow the discrimination between the different types of PE and treatments. Clinical approaches should consider the sexual behavior and relationship of the patient and their distress.

dos Reis M de MF, Barros EAC, Monteiro L, et al. Premature Ejaculation Among Internet Users Living in the Metropolitan Region of São Paulo, Brazil: A Cross-Sectional Comparison Between the Premature Ejaculation Diagnostic Tool (PEDT) and Patient-Reported Latency Time and Perception. Sex Med 2022;10:100463.

[Behavioral predisposing and social habits related to sexual life in university students]

BACKGROUND

University students are usually a risk group in terms of their sexual life, either because of social habits or because of the behavioral predisposers to which they are exposed. This article analyse the relationship between these factors.

OBJECTIVE

To establish the frequency and relationship between behavioral and social predisposers with active sexual life (ASL) in university students.

MATERIAL AND METHODS

Cross-sectional study, carried out in 360 medical students. The data of sexual life and the behavioral and social factors associated with it were analyzed through prevalences with their confidence intervals, as well as the calculation of the Odds Ratio (OR).

RESULTS

The results showed that 58.9% (95%CI: 53.7%-63.9%) of the students have ever had sexual intercourse. The only behavioral predisposing associated with ASL was the absence of religious practices (OR: 2.6; 95%CI: 1.6-4.1; p < 0.001), while all the habits and social behaviors analyzed were significantly associated with ASL, the most common being attendance at parties (77.8%) and the consumption of alcoholic beverages (67.2%).

CONCLUSIONS

Our results show that young people present a wide range of behavioral and social characteristics that influence their sexual life, therefore, implementing strategies aimed at protecting sexual and reproductive health is also necessary in this age group.

The Impact of the COVID-19 Pandemic on Sexual Behaviors: Findings From a National Survey in the United States

BACKGROUND

Studies from the first months of the coronavirus disease 2019 (COVID-19) pandemic and the resulting lockdown and social distancing measures have shown that there have been decreases in sexual frequency and relationship satisfaction.

AIM

To evaluate the ongoing impact of the COVID-19 pandemic on sexual behavior, relationship satisfaction, and intimate partner violence in the United States using a large national convenience sample.

METHODS

About 1,051 participants across the United States were recruited in October 2020 to complete a cross-sectional online survey.

OUTCOMES

Participants were asked to retrospectively report their sexual behavior frequency, relationship satisfaction, and intimate partner violence during the pandemic and prior to the pandemic RESULTS: There was a small but significant decrease in some retrospectively-reported partnered sexual activities, and men reported a small increase in masturbation and pornography use. There was no evidence for a change in relationship satisfaction or intimate partner violence, but both men and women reported a small decrease in sexual pleasure, and women reported a small decrease in sexual desire. The sexual behaviors with greatest reduction were casual sex, hookups, and number of partners, and the most diminished as aspect of sexual functioning was sexual enjoyment. Depression symptoms, relationship status, and perceived importance of social distancing emerged as predictors of these reductions. Less than half of individuals who engaged with casual sex partners before the start of the pandemic ceased this behavior completely after the start of the pandemic. Individuals waited on average 6-7 weeks before reengaging in casual sex.

CLINICAL IMPLICATIONS

These results inform public health response to the effects of the pandemic and add to our understanding of how the pandemic has continued to impact sexual behavior.

STRENGTHS AND LIMITATIONS

This is the first known study to evaluate sexual behavior several months into the COVID-19 pandemic using a large national sample. However, the results of this study are limited by its convenience sampling method and cross-sectional design.

CONCLUSION

These results indicate that the changes in sexual behavior observed in the early months of the pandemic have continued, with small but significant decreases in many partnered sexual behaviors and a small increase in men's solitary sexual behaviors. Gleason N, Banik S, Braverman J, et al. The Impact of the COVID-19 Pandemic on Sexual Behaviors: Findings From a National Survey in the United States. J Sex Med 2021;18:1851-1862.

Factors associated with condom and contraceptive use among currently and formerly homeless young adults: Does housing matter?

BACKGROUND

Young adults that experience homelessness (YAEH) are at heightened risk of unplanned pregnancy and contracting STIs, including HIV than their housed counterparts. It is unclear how exiting homelessness into Supportive Housing (SH), the most prominent intervention in homelessness, may shape sexual risk-taking.

OBJECTIVE

The goal of this study is to explore associations of condom and contraception use with particular interest in the role of partner type (i.e., casual and/or serious) and housing status.

METHODS

This study includes 143 sexually active YAEH (ages 18-27) who reported engaging in vaginal sex during the past three months: 67 "unhoused" (i.e., street-based, couch-surfers, or staying in emergency shelter), and 76 "housed" from SH programs. Multiple logistic regression examined the relationship of housing status and partner type with condom and contraceptive use.

RESULTS

Being a parent was associated with higher odds of contraceptive use regardless of housing status, while partner type (i.e., serious or casual partner) was differently associated with condom use by housing status.

DISCUSSION

Despite documented differences in condom-using behaviors by housing status, findings revealed similar patterns in contraceptive use between the two groups, indicating a possible need for enhanced and targeted service planning for YAEH, particularly among those transitioning to and residing in SH, regarding contraceptive use and prevention.

Predictors of Sexual Satisfaction in Women: A Systematic Review

INTRODUCTION

The increasing research interest in sexual satisfaction corresponds to a large amount of studies which focus on different singular determinants without establishing a common model for its explanation.

OBJECTIVES

The purpose of this review is to systematically identify and evaluate the structure and results of the current research about sexual satisfaction in heterosexual women in a long-term relationship.

METHODS

A systematic literature search using Web of Knowledge, ProQuest and PSYNDEX was conducted from January 2004 to October 2019. In total, 1,649 studies published in the last 15 years were extracted from the databases with a systematic keyword search. Through a multistage evaluation process 204 studies met the inclusion criteria and described findings about sexual satisfaction as dependent variable.

RESULTS

Research interest in sexual satisfaction increased notably in the last 5 years. Empirical analyses were predominantly based on data from North America whereas a considerably smaller share of research analyzed samples from Europe or Asia. Relationship variables were the most frequently analyzed predictors and included in more than half of the identified studies. Sexual behavior was most often analyzed in the form of frequency of sexual interactions. Contrariwise, sexual practices, communication about sexuality and sexual desire, and sexual thoughts received limited attention. Demographics were considered in one third of all studies. The inclusion of control variables was rare. Some important studies considered variables closely related to sexual satisfaction such as sexual dysfunction.

CONCLUSION

Relationship satisfaction and the frequency of sexual interactions are identified as the most frequently confirmed predictors of sexual satisfaction across all evaluated studies. Results about the effects of pornography consumption, religion, and relationship duration showed the greatest inconsistency. In general, identified effects were often believed to result from mediator variables like sexual desire or distracting thoughts. Rausch D, Rettenberger M. Predictors of Sexual Satisfaction in Women: A Systematic Review. Sex Med Rev 2021;9:365-380.

Validation of the Maternal and Partner Sex During Pregnancy Scales (MSP/PSP) in Portugal: Assessing Dyadic Interdependence and Associations with Sexual Behaviors

BACKGROUND

The Maternal and Partner Sex During Pregnancy Scales (MSP/PSP) are self-report measures of expectant couples' attitudes towards sex during pregnancy.

AIM

This study aimed to examine dyadic non-independence of MSP/PSP scores in a sample of expectant couples, while providing an evaluation of factor structure, validity, and reliability of the Portuguese versions of the MSP/PSP. The association between partners' attitudes and frequency of sexual behaviors was also examined.

METHODS

A total of 189 expectant couples completed a survey that included a sociodemographic questionnaire, the MSP/PSP, frequency of sexual behaviors, as well as validated measures of attitudes to sex, sexual function, sexual satisfaction, depression, and perceived social support.

OUTCOMES

Dyadic interdependence was tested via Pearson correlation between MSP/PSP scores; between-dyads variability was tested via intraclass correlation of the unconditional model including only MSP/PSP scores using a multi-level model. Associations between attitudes and sexual behavior were tested using regression analysis (between-dyads outcomes) or APIM (mixed outcomes). Factor structure, internal consistency, and validity (convergent, discriminant, and concurrent) of the Portuguese versions of the scales were assessed.

RESULTS

MSP/PSP scores were interdependent within-dyads. Male partners presented significantly more positive attitudes towards sex during pregnancy than pregnant women. Attitudes were linked to indices of sexual well-being for both partners (sexual functioning, sexual satisfaction) and, for both partners, more positive attitudes were associated with higher frequencies of most partnered sexual behaviors. The Portuguese MSP/PSP scales showed good factor structure, and good to excellent indices of reliability and validity.

CLINICAL IMPLICATIONS

The Portuguese MSP/PSP is adequate for use in couples. The scales can be used to screen partners with negative attitudes towards sex during pregnancy and evaluate how these attitudes relate to intra- and inter-individual sexual well-being during pregnancy.

STRENGTHS & LIMITATIONS

A strength of this study is the inclusion of both expectant partners and the use of dyadic analysis. Couples who participated in the study were all in mixed-gender/sex relationships, although this was not defined as an inclusion criterion. Future studies should use the MSP/PSP in more diverse samples in order to further determine how the scale performs for couples with different characteristics.

CONCLUSION

Scores in the MSP/PSP are interdependent between mixed-sex/gender expectant couple members. More positive attitudes towards sex during pregnancy are linked to higher frequencies of partnered sexual behaviors and to both partners' greater sexual well-being. Tavares Inês M., Heiman Julia R., Rosen Natalie O., et al. Validation of the Maternal and Partner Sex During Pregnancy Scales (MSP/PSP) in Portugal: Assessing Dyadic Interdependence and Associations with Sexual Behaviors. J Sex Med Rev 2021;18:789-799.

An Examination of Empathy and Interpersonal Dominance in BDSM Practitioners

BACKGROUND

Recent research has indicated that participation in BDSM (bondage-discipline, dominance-submission, and/or sadism-masochism) is not associated with psychological distress or psychopathology but that sexual roles may be associated with personality characteristics, specifically interpersonal dominance and empathy.

AIM

The present study examined potential differences between those who identify as dominant, switch, and submissive on interpersonal dominance and empathy.

METHODS

Individuals who identified as members of the BDSM community were recruited online via a social networking site.

MAIN OUTCOME MEASURES

Self-reported demographic variables, the Personality Assessment Inventory, Dominance subscale, and the Interpersonal Reactivity Index Empathic Concern subscale.

RESULTS

Participants were well distributed across sexual roles (n = 279; 25.4% dominant, 38% submissive, 36.6% switch), identified as primarily female (59.5%), primarily heterosexual (53.4%), and the most common age group was 25-34 years (27.2%). BDSM role was associated with scores on the Dominance subscale; dominant BDSM practitioners scored significantly higher on the Dominance scale than switches, who in turn scored significantly higher than submissives (dominant mean [M] = 61.44, standard deviation [SD] = 8.26; switch M = 53.99, SD = 11.18, P < .01; submissive M = 49.41, SD = 11.46, P < .01). There were no differences on the measure of empathy between dominant, submissive, and switch BDSM practitioners. On average, individuals who identified as submissives and switches scored in the average range on the Dominance scale compared with the normative sample, and individuals who identified as dominants scored higher but not in the markedly elevated range.

CLINICAL IMPLICATIONS

The study provides information on the relationship between interpersonal dominance as a personality trait and dominance as a sexual role and has implications for reducing stigma related to these practices.

STRENGTHS AND LIMITATIONS

The study contributes to the growing literature suggesting that while BDSM roles may correspond with specific personality characteristics, they are not indicative of personalities significantly different than the general population's. The study also included individuals who identified as switch, a group often excluded from quantitative research in the BDSM community. The sample was, however, recruited exclusively online, and findings may not be applicable to all BDSM practitioners.

CONCLUSION

These findings suggest that there are no differences in empathy between BDSM practitioner roles, and although there are differences in interpersonal dominance, these characteristics are not likely to be prominent in individuals' everyday interactions. Jansen KL, Fried AL, Chamberlain J. An Examination of Empathy and Interpersonal Dominance in BDSM Practitioners. J Sex Med 2021;18:549-555.

The Impact of COVID-19 on Sexual Health: A Preliminary Framework Based on a Qualitative Study With Clinical Sexologists

INTRODUCTION

In recent months, some attempts were made to understand the impact of COVID-19 on sexual health. Despite recent research that suggests COVID-19 and lockdown measures may eventually impact sexual response and sexually related behaviors, we are missing clinical sexologists' perspectives on the impact of COVID-19 in sexual health. Such perspectives could inform a preliminary framework aimed at guiding future research and clinical approaches in the context of COVID-19.

AIM

To explore the perspectives of clinical sexologists about the impact of COVID-19 on their patients' sexual health, as well as the professional challenges they have faced during the current pandemic. Findings are expected to inform a preliminary framework aimed at understanding the impact of COVID-19 on sexual health.

METHODS

We conducted an online qualitative exploratory survey with 4 open-ended questions with 39 clinical sexologists aged between 32 and 73 years old. The survey was advertised among professional associations' newsletters. We performed a Thematic Analysis using an inductive, semantic, and (critical) realist approach, leading to a final thematic map.

MAIN OUTCOME MEASURES

The outcome is the thematic map and the corresponding table that aggregates the main themes, subthemes, and codes derived from participants' answers and that can serve as a preliminary framework to understand the impact of COVID-19 on sexual health.

RESULTS

The final thematic map, expected to serve as a preliminary framework on the impact of COVID-19 in sexual health, revealed 3 main themes: Clinical Focus, Remapping Relationships, and Reframing Technology Use. These themes aggregate important interrelated issues, such as worsening of sexual problems and dysfunctions, mental health, relationship management, the rise of conservatism, and the use of new technology that influences sexuality and sexual health-related services.

CONCLUSION

The current study allowed us to develop a preliminary framework to understand the impact of COVID-19 on sexual health. This framework highlights the role of mental health, as well as the contextual nature of sexual problems, and subsequently, their relational nature. Also, it demonstrates that the current pandemic has brought into light the debate of e-Health delivery within clinical sexology. Pascoal PM, Carvalho J, Raposo CF, et al. The Impact of COVID-19 on Sexual Health: A Preliminary Framework Based on a Qualitative Study With Clinical Sexologist. Sex Med 2021;9:100299.

Risk of sexually transmitted Zika virus in a cohort of economically disadvantaged urban residents

In order to understand the disease burden of sexually transmitted Zika virus (ZIKV), we prospectively followed a cohort of 359 adult and adolescent residents of an urban community in Salvador, Brazil through the 2015 ZIKV epidemic. Later, in 2017, we used a retrospective survey to associate sexual behavior during the epidemic with ZIKV infection as defined by IgG3-NS1 ELISA. We found that males who engaged in casual sexual encounters during the epidemic were more likely (ORa=6.2; 95%CI 1.2-64.1) to be ZIKV positive, suggesting that specific groups may be at increased risk of sexually transmitted infections.

COVID-19 and the Changes in the Sexual Behavior of Men Who Have Sex With Men: Results of an Online Survey

BACKGROUND

Social distancing in the wake of the coronavirus disease 2019 (COVID-19) pandemic may affect the sexual behavior of men who have sex with men (MSM). In early March 2020, Israel imposed travel restrictions and limited social contacts to household members only. The effects of these restrictions on the sexual behavior and mental health of MSM are unknown.

AIM

To assess sexual behaviors and mental health of Israeli MSM during social distancing and to compare sexual behaviors before and during social distancing, due to the COVID-19 pandemic.

METHODS

Data were collected through anonymous web-based questionnaires in a popular geospatial application used by MSM between March and April 2020 during the social-distancing period.

OUTCOMES

The dependent variable was casual sex, in violation of social-distancing regulations. Independent variables were demographic characteristics, sexual behaviors before and during social-distancing restrictions, and mental health.

RESULTS

Of the 2,562 participants, 1,012 (39.5%) continued to meet new casual sex partners during this period. Being of a younger age, single, and with higher levels of mental distress predicted engagement in casual sex during the social-distancing period. MSM reduced their sexual risk and limited sexual repertoire-in particular, kissing with their sexual partners. Participants also spent more time in dating applications than in the pre-social-distancing period and increased their use of sex phone, webcams, and porn consumption. They perceived the threat of severe acute respiratory syndrome coronavirus to be greater than that of HIV: only 3.2% could imagine themselves having sex with a partner who is infected with SARS-CoV-2 compared with 30.1% in case of HIV, P < .01.

CLINICAL IMPLICATIONS

MSM reduced their risk behaviors during social distancing because of the threat of COVID-19. Casual sex during social distancing was associated with negative feelings of mental distress. Future public health response in the future waves of COVID-19 morbidity should strike a balance between containment measures and the need for social distancing with its possible mental and social burdens.

STRENGTHS AND LIMITATIONS

This is the first study in Israel and one of the few in the world to examine sexual behaviors among MSM during the COVID-19 social distancing period. It involved a relatively large sample, through convenience sampling, which limits causality. Findings should be interpreted cautiously, specifically because COVID-19-related behaviors and circumstances may change rapidly.

CONCLUSION

The negative feelings of distress due to social distancing should be considered as a potential barrier to adherence among vulnerable populations, such as MSM. Future public health response should strike a balance between containment measures and its possible mental, social, and financial burdens. Shilo G, Mor Z. COVID-19 and the Changes in the Sexual Behavior of Men Who Have Sex With Men: Results of an Online Survey. J Sex Med 2020;17:1827-1834.

Bullying Victimization and Sexual Behavior Among Adolescents Aged 12-15 Years From 53 Countries: A Global Perspective

BACKGROUND

Identifying correlates of sexual behavior among young adolescents is critical for preventing adverse outcomes linked to such behavior.

AIM

This study examined the relationship of bullying victimization with sexual intercourse, multiple sexual partners, and non-condom use in adolescents aged 12-15 years across 53 countries.

METHODS

Cross-sectional data from 145,342 adolescents aged 12-15 years participating in the Global School-based Student Health Survey 2003-2016 were analyzed. Data on bullying victimization were assessed by the question "During the past 30 days, on how many days were you bullied?"

OUTCOMES

Data on several sexual behaviors were collected: (i) ever having had intercourse, among those who reported having had intercourse; (ii) multiple (≥2) lifetime sexual partners; and (iii) condom use in last sexual intercourse.

RESULTS

Multivariable logistic regression analyses were used to assess the associations. The overall prevalence of any bullying in the past 30 days and lifetime sexual intercourse were 28.8% and 13.1%, respectively. Compared with those who were not bullied in the past 30 days, those who were bullied for 20-30 days were 2.08 (95% CI = 1.65-2.63), 1.70 (95% CI = 1.10-2.63), and 1.72 (95% CI = 1.12-2.67) times more likely to report sexual intercourse, non-condom use, and multiple sex partners, respectively.

CLINICAL IMPLICATIONS

This study provides further evidence that bullying victimization is a global phenomenon and interventions are required to reduce its prevalence and unwanted consequences.

STRENGTHS & LIMITATIONS

The main strength was the large sample of young adolescents across 53 countries. However, findings from the present study should be interpreted in light of its limitations. First, the study was cross-sectional in nature and thus the direction of the association cannot be established. Second, the data only included young adolescents who attend school. Third, data were self-reported and thus reporting bias may exist. Fourth, the measure of sexual activity used was not able to distinguish between penetrative and nonpenetrative sex. Fifth, adolescents who are victims of bullying may also be exposed to other types of violence such as child maltreatment and sexual assaults, for which data were not available. Finally, the present data set did not contain data on sexual orientation.

CONCLUSION

These findings highlight the need for interventions either acting to educate about the potential negative consequences or to prevent risky sexual behavior in young adolescents who experience bullying victimization. Smith L, Grabovac I, Jacob L, et al. Bullying Victimization and Sexual Behavior Among Adolescents Aged 12-15 Years From 53 Countries: A Global Perspective. J Sex Med 2020;17:2148-2155.

Patterns and Trajectories of Anal Intercourse Practice Over the Life Course Among US Women at Risk of HIV

INTRODUCTION

Condomless anal intercourse (AI) confers a far greater likelihood of HIV transmission than condomless vaginal intercourse (VI). However, little is known about AI practice over the life course of women, to what extent AI practice is condom-protected, and whether it is associated with other HIV risk behaviors. We aim to describe longitudinal AI practice among HIV-seronegative women and to identify subgroups with distinct trajectories of AI practice.

METHODS

Using data from the Women's Interagency HIV Study, an observational cohort of US women with or at risk for HIV, we described AI practice among HIV-seronegative participants. Group-based trajectory modeling was used to identify distinct AI trajectories. We used multinomial regression to examine associations between baseline characteristics and trajectory group membership.

RESULTS

A third of the 1,085 women in our sample reported any AI over follow-up (median follow-up = 14 years). AI decreased more sharply with age compared to VI. Consistent condom use during AI was low: twice the proportion of women never reported using condoms consistently during AI compared to during VI. 5 trajectory groups were identified: AI & VI persistors (N = 75) practiced AI and VI consistently over follow-up (AI & VI desistors (N = 169) tended to practice AI and VI when young only, while VI persistors (N = 549), VI desistors (N = 167), and AI & VI inactives (N = 125) reported varying levels of VI practice, but little AI. AI & VI persistors reported multiple male partners and exchange sex at more visits than other groups. Women who identified as bisexual/lesbian (vs heterosexual), who had ever experienced physical and sexual violence (vs never), and/or who reported above the median number of lifetime male sex partners (vs median or below) had approximately twice the odds of being AI & VI persistors than being VI persistors.

CONCLUSIONS

We identified a small subgroup of women who practice AI and report inconsistent condom use along with other risk behaviors throughout the life course; they may therefore particularly benefit from ongoing access to HIV prevention services including pre-exposure prophylaxis. Owen BN, Baggaley RF, Maheu-Giroux M, et al. Patterns and Trajectories of Anal Intercourse Practice Over the Life Course Among US Women at Risk of HIV. J Sex Med 2020;17:1629-1642.

Qualitative Analysis of Treatment Needs in Interstitial Cystitis/Bladder Pain Syndrome: Implications for Intervention

BACKGROUND

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating condition carrying substantial psychosocial burden. Psychological treatment for IC/BPS is little studied, and there are barriers to its use in clinical management. Whether psychological treatments benefit patients with IC/BPS is unclear and we do not know if such treatments would meet patient needs.

AIMS

Incorporating patient-reported needs and acknowledging diversity in pain experiences can inform patient-centered interventions for IC/BPS. This project characterized the experience of living with IC/BPS and patient perceptions of needs in its treatment, with the goal of informing patient-centered treatment for IC/BPS.

METHODS

Using both quantitative and qualitative methods, 27 females with IC/BPS participated in a focus group and completed validated self-report assessments evaluating urinary symptoms, pain, and emotional functioning. Focus groups were audio recorded and transcribed, then coded and analyzed using an iterative inductive/deductive approach. Linear regression models evaluated the relationship between psychological functioning and symptom severity.

RESULTS

We conducted six focus groups between 8/2017-12/2017. Five major themes emerged from qualitative analysis: managing physical symptoms, emotional symptoms, impact on daily life and socio-contextual factors, responding to illness, and addressing needs in treatment. The physiological and emotional consequences of IC/BPS were reported, highlighting their impact on interpersonal relationships and challenges obtaining appropriate treatment for IC/BPS. Quantitative analysis showed depression levels were significantly associated with worsened IC/BPS symptomology, after controlling for known confounding factors.

CONCLUSION

Individuals with IC/BPS could benefit from tailored psychological interventions focusing on pain management, emotion regulation, communications skills, along with sexual dysfunction and intimacy fears.

Meeting Sexual Partners Online and Associations With Sexual Risk Behaviors in the Swedish Population

BACKGROUND

Online arenas may facilitate sexual encounters. However, to what extent finding sexual partners online is associated with sexual risk behavior and sexual health outcomes is still not fully explored.

METHODS

A stratified randomized population based study on sexual and reproductive health and rights of 50,000 Swedes was conducted in 2017. The final sample consisted of 14,537 women and men aged 16-84 years. We identified sexual health factors associated with finding sexual partners online and estimated prevalences thereof.

RESULTS

Having used the internet to meet sexual partners was reported by 11% (95% confidence interval: 10.1-12.3) of men and 7% (95% confidence interval: 6.0-7.4) of women and was most common among men aged 30-44 years (13.7%). After adjustment, those reporting a non-heterosexual identity were most likely to meet sexual partners online. Meeting sexual partners online was also associated with reporting several sexual risk behaviors: condomless sex with temporary partner during the past 12 months, adjusted odds ratio (AOR): 5.1 (3.8-6.8) for women and AOR: 6.0 (4.5-7.9) for men, and having had a test for sexually transmitted infections (STIs) generated a 4-fold AOR for both sexes, STI diagnosis showed a 2-fold AOR, ever having paid or given other compensation for sex AOR: 4.8 (2.7-8.8) for women and AOR: 4.2 (2.9-6.1) for men as well as ever having received money or other compensation for sex AOR: 4.0 (1.3-11.9) for women and AOR: 6.0 (2.4-15.1) for men.

CLINICAL TRANSLATION

Meeting sexual partners online was associated with sexual risk behaviors, which is of importance in tailoring sexual health interventions and STI/HIV-control activities.

STRENGTHS AND LIMITATIONS

Few studies of online sexual behaviors are based on population-based surveys of the general population with results stratified by sexual identity. However, the use of lifetime prevalence of ever having used the internet, smartphone, or app to meet sexual partners has limitations.

CONCLUSION

Meeting sexual partners online was associated with sexual risk behaviors in a randomized sample of the Swedish population, which is of importance to tailoring sexual health interventions. Deogan C, Jacobsson E, Mannheimer L, et al. Meeting Sexual Partners Online and Associations With Sexual Risk Behaviors in the Swedish Population. J Sex Med 2020;17:2141-2147.

Kamasutra in Practice: The Use of Sexual Positions in the Czech Population and Their Association With Female Coital Orgasm Potential

INTRODUCTION

A limited number of scientific studies explore the frequency with which various sexual positions are used in human populations and the potential of particular sexual position to facilitate female coital orgasm.

AIM

The aim of this study was to provide data about the prevalence and frequency of various sexual positions, their rated pleasurability, and their association with female coital orgasm consistency (COC).

METHODS

A sample of Czech heterosexual population (11,225 men/9,813 women) were presented with a list of 13 sexual positions in black-and-white silhouettes. For each position, they indicated frequency and pleasurability. COC was assessed as the proportion of penile-vaginal intercourse with a current partner which led to orgasm.

MAIN OUTCOME MEASURE

Participants reported the frequency of use of sexual positions and rated their pleasurability. Using ordinal logistic regression, association between the COC and frequency of use of coital positions was tested.

RESULTS

In both men and women, the most commonly used sexual positions were face to face/male above, face to face/female above, and kneeling/rear entry. Nonetheless, there emerged some gender differences in the rating of pleasurability of various positions (all P < .001). We found that a higher proportion of female coital orgasms are positively associated with the frequency of use of face to face/female above (odds ratio [OR] = 1.005, P < .001) and sitting/face-to-face positions (OR = 1.003, P < .001) and negatively associated with the frequency of kneeling/rear entry position (OR = 0.996, P < .001).

CONCLUSIONS

Our findings suggest that there are no gender differences in the frequency of use of sexual positions, but their rated pleasurability differs between men and women, and higher frequency of use of face-to-face positions with female above increases the likelihood of achieving coital orgasm during penile-vaginal intercourse. Most results, however, were of small effect sizes, and more research is needed to further explore this issue. Krejčová L, Kuba R, Flegr J, et al. Kamasutra in Practice: The Use of Sexual Positions in the Czech Population and Their Association With Female Coital Orgasm Potential. Sex Med 2020;8:767-776.

Chronic Maternal Tobacco Smoke Exposure and/or Alpha-Lipoic Acid Treatment Causes Long-Term Deterioration of Testis and Sexual Behavior in Adult Male Rats

BACKGROUND

Tobacco use during pregnancy is known to have several negative effects on the offspring's reproductive health in the long term. The use of alpha-lipoic acid (ALA) as a dietary supplement during pregnancy has increased greatly in recent years and has been known to have positive effects on various pregnancy outcomes including miscarriage, diabetic embryopathy, preterm delivery, and congenital malformations.

AIM

To evaluate the effects of tobacco smoke exposure (TSE) on sexual behavior, reproductive parameters, and testicles in adult male rats and to reveal the possible role of ALA administration on these parameters.

METHODS

Pregnant rats (n = 7 per group) were treated with tobacco smoke (TS), ALA (20 mg/kg), and TS + ALA for a total of 11 weeks. The following parameters were compared with 8 control rats: puberty parameters, sexual behavior; levels of serum gonadotropins and testosterone, total antioxidant status, and total oxidant status; the expression of the apoptotic protease-activating factor-1 and caspase 9 mRNA levels in the testis; and assessment of immunohistochemistry and terminal deoxynucleotidyl transferase dUTP nick end labeling assay of testis.

MAIN OUTCOME MEASURE

Sexual behavior, changes in puberty parameters, and hormonal and genetic alterations were the outcomes analyzed in this study.

RESULTS

Maternal TSE caused a significant decrease in the number of intromissions compared to the control group. Similarly, ALA decreased erectile function in sexual behavior by decreasing the number of intromissions and intromission ratio in the ALA group compared to the control group. In addition, TSE and ALA treatment caused an impairment of some consummatory sexual behaviors. Also, in parallel with this inhibitory effect, the age of pubertal onset was significantly delayed in the TS + ALA group compared to other groups. Also, histopathological changes in testicular tissue, oxidative stress markers, apoptotic index, and mRNA levels of apoptosis-related genes increased in all treatment groups.

CLINICAL IMPLICATIONS

The use of ALA and/or tobacco products during pregnancy may adversely affect the reproductive health of male newborns in the long term.

STRENGTHS & LIMITATIONS

To the best of our knowledge, this study is the first to show the effects of maternal ALA treatment and/or TSE on the sexual behavior and reproductive parameters in male rats; however, the study is based on an animal model, and the present findings partially reflect the characteristics of human sexual behavior.

CONCLUSION

Maternal TSE and/or ALA treatment may impair sexual behavior in adulthood in male rats because of testicular damage caused by oxidative stress during gonadal development. Yardimci A, Akkoc RF, Tektemur A, et al. Chronic Maternal Tobacco Smoke Exposure and/or Alpha-Lipoic Acid Treatment Causes Long-Term Deterioration of Testis and Sexual Behavior in Adult Male Rats. J Sex Med 2020;17:1835-1847.

Physical Intimacy Is an Important Part of Sexual Activities: Korean Older Adults Study

INTRODUCTION

Sexual activity can be broadly defined to include not only sexual intercourse but also physical intimacy. However, most studies of sexual activity in older adults have a limited focus on sexual intercourse only.

AIM

The aim was to investigate sexual activities including sexual intercourse and physical intimacy in community-dwelling older Korean adults.

METHODS

This study was based on cross-sectional data to measure sexual activities (sexual intercourse and physical intimacy) in 209 participants (100 men and 109 women) aged 65 years or older. Sexual intercourse and physical intimacy were defined as vaginal penetration and as any sexual behavior with sexual arousing (eg, kissing, caressing), respectively. Erectile dysfunction was evaluated by the use of the International Index of Erectile Function questionnaire, and female sexual dysfunction was evaluated by Female Sexual Function Index scores.

MAIN OUTCOME MEASURE

Trained interviewers collected the survey information on sexual activities in the last 6 months at the senior welfare center.

RESULTS

The participants' mean age was 73.4 ± 4.8 years (men, 74.2 ± 5.0 years; women, 71.6 ± 5.3 years). The prevalence of erectile dysfunction was 91.0% (91/100), and the prevalence of female sexual dysfunction was 96.3% (105/109). In the previous 6 months, 122 participants (58.4%) reported sexual activities, and men reported more sexual activities than women (P = .001). A total of 69.6% of men and 41.9% of women engaged in sexual activity with intercourse, whereas 30.4% of men and 58.1% of women engaged in physical intimacy only. The physical intimacy-only group was more likely to have erectile dysfunction or female sexual dysfunction than the sexual intercourse group (P = .035 and P = .012, respectively).

CONCLUSIONS

Although sexual intercourse is an important part of sexual activity, our study results suggest that physical intimacy is also a considerable component of sexual activity that should not be neglected in older adults, especially in women. Our findings imply that health-care professionals need to consider physical intimacy as part of sexual activity in the assessment of geriatric patients with sexual dysfunction. Chung HS, Kim GH, Shin M-H, et al. Physical Intimacy Is an Important Part of Sexual Activities: Korean Older Adults Study. Sex Med 2020;8:643-649.

Impact of the COVID-19 pandemic on the sexual behavior of the population. The vision of the east and the west

The COVID-19 pandemic has radically changed the way of life around the World. The state of alarm has forced the population to stay at home, radically changing both interpersonal and partner relationships; work at home, social distancing, the continued presence of children at home, fear of infection and not being able to physically meet with others have changed most people's sexual habits. We conducted a review by exploring the impact of the COVID-19 pandemic on sexual behavior in the population from three different countries: Iran, Italy and Spain from each country's perspective. The impact of the coronavirus will be very important in the sexual life of the people and we will attend in the next months or years, to some changes in the relationships at all the levels. The pandemic will negatively affect sexual behaviors due to multiple contact restrictions. In the future, we will be able to assess these effects in more detail.

Effects of mesh surgery on sexual function in pelvic prolapse and urinary incontinence

Purpose:

We aimed to determine pre-operative and post-operative sexual function scores of patients who underwent four-arm polypropylene mesh implantation surgery to treat urinary incontinence and pelvic organ prolapse.

Materials and Methods:

A prospective study from January 2011 to November 2015 including patients (n: 72) submitted to surgical mesh implantation (four-arm anterior mesh implant (Betamix POP4®, Betatech Medical, Turkey) questioned the patients with Female Sexual Function Index evaluation form. The questionnaire was applied to all patients at pre-operative, post-operative 3rd month and post-operative 1st year periods.

Results:

The mean age of the patients was 47.2±7.1 years. The mean Body Mass Index (kg/m2) was 28.7±3.7. The average of incontinence duration (year) was 4.6±2.6 and the average for operation time (min) was 35.7±2.1. After the urinary incontinence and pelvic organ prolapse surgery, it was observed that incontinence complaints of patients reduced. Furthermore, there was a positive change in quality of life and sexual function of patients at the post-operative period. There was a statistically significant increase according to Female Sexual Function Index score among all three periods (16%, 86% and 100% respectively, p=0.001) and improvement of sexual functions was observed.

Conclusions:

Transvaginal mesh use in the surgical treatment of pelvic organ prolapse improves quality of life. However, risk factors such as transvaginal mesh usage indication, surgical technique and experience of the surgeon, suitability of the material, the current health status of the patient and postoperative personal care of the patient may affect the success of operations.

Patient and Partner Sexual Concerns During the First Year After an Implantable Cardioverter Defibrillator: A Secondary Analysis of the P+P Randomized Clinical Trial

BACKGROUND

Sexual concerns and changes in sexual activity are common among patients and their intimate partners after an implantable cardioverter defibrillator (ICD).

AIMS

Our aims were to (i) describe patient and partner sexual activity and related concerns from the time of an initial ICD implant through 12-month follow-up and (ii) identify factors predictive of return to sexual activity and fears associated with sexual activity.

METHODS

This secondary descriptive analysis was conducted with data from a randomized controlled trial (2009-2015) designed to compare 2 interventions for patients (Patient-Only) and for patients and their partners (Patient+Partner) after implant of an initial ICD. The sample included 105 patients and their intimate partners who reported sexual activity during the 24 months before ICD implant.

OUTCOMES

The Sexual Concerns Inventory was used to assess sexual activity and related concerns.

RESULTS

Study participants comprised 72% male and were of mean age 65.6 ± 10.6 years; partners comprised 64% female and were of mean age 63 ± 11.6 years. Sexual activity increased after ICD: 73% of patients reported no sexual intercourse during 2 months before study enrollment, whereas only 46% reported no sexual intercourse during the 2 months before 12-month follow-up. Reductions in sexual concerns were evident 1 month after implant, with continued reductions through 12 months (patient 6.48 ± 4.03 to 5.22 ± 3.38, P = .004; partner 6.93 ± 4.01 to 5.2 ± 3.56, P < .001). Patient physical health predicted sexual activity 3 months after implant placement (P = .04); general ICD concerns (P < .001) predicted patient ICD-related sexual fears at 3 months. At 12 months, baseline general ICD concerns (P < .02) predicted sexual fears.

CLINICAL IMPLICATIONS

ICD patients and partners report low levels of sexual activity at the time of initial ICD implant, with reported increases in sexual activity over the 12-month recovery period: Sexual concerns were highest immediately after ICD implant.

STRENGTHS & LIMITATIONS

Notably, the major strengths of this study were the repeated measures and longitudinal study design; the main limitation of the study was the lack of a "usual care" control group.

CONCLUSION

Sexual activity at the time of an initial ICD implant is low, and sexual concerns are most prominent for both patients and partners immediately after implant placement. Baseline physical health predicts subsequent sexual activity at 3 months, while general ICD-related worry predicts sexual fears at 3 and 12 months. Streur MM, Rosman LA, Sears SF, et al. Patient and Partner Sexual Concerns During the First Year After an Implantable Cardioverter Defibrillator: A Secondary Analysis of the P+P Randomized Clinical Trial. J Sex Med 2020;17:892-902.

Diverse Sexual Behaviors and Pornography Use: Findings From a Nationally Representative Probability Survey of Americans Aged 18 to 60 Years

BACKGROUND

Convenience sample data indicate that substantial portions of adults have engaged in sexual behaviors sometimes described as rough; little is known about these behaviors at the population level.

AIM

To describe, in a U.S. probability sample of Americans aged 18 to 60 years, (i) the prevalence of diverse sexual behaviors, described here as dominant and target behaviors; (ii) the age at first pornography exposure as well as prevalence, range, and frequency of pornography use; (iii) the association between past year pornography use frequency and dominant/target sexual behaviors; and (iv) associations between lifetime range of pornography use and dominant/target sexual behaviors.

METHODS

A confidential cross-sectional online survey was used in this study.

OUTCOMES

Lifetime engagement in dominant behaviors (eg, spanking, choking, name calling, performing aggressive fellatio, facial ejaculation, penile-anal penetration without first asking/discussing) and lifetime engagement in target behaviors (eg, being spanked, being choked, being called names during sex, having their face ejaculated on, receiving aggressive fellatio, or receiving penile-anal penetration without having discussed) were assessed; lifetime pornography use, age at first porn exposure, past-year frequency of porn viewing, and lifetime range of pornography were also assessed.

RESULTS

Women as well as men who have sex with men were more likely to report target sexual behaviors: having been choked (21.4% women), having one's face ejaculated on (32.3% women, 52.7% men who have sex with men), and aggressive fellatio (34.0% women). Lifetime pornography use was reported by most respondents. After adjusting for age, age at first porn exposure, and current relationship status, the associations between pornography use and sexual behaviors was statistically significant.

CLINICAL IMPLICATIONS

Clinicians need to be aware of recent potential shifts in sexual behaviors, particularly those such as choking that may lead to harm.

STRENGTHS & LIMITATIONS

Strengths include U.S. probability sampling to provide population level estimates and the use of Internet-based data collection on sensitive topics. We were limited by a lack of detail and context related to understanding the diverse sexual behaviors assessed.

CONCLUSION

Clinicians, educators, and researchers have unique and important roles to play in continued understanding of these sexual behaviors in the contemporary United States. Herbenick D, Fu T-C, Wright P, et al. Diverse Sexual Behaviors and Pornography Use: Findings From a Nationally Representative Probability Survey of Americans Aged 14 to 60 Years. J Sex Med 2020;17:623-633.

Oral Transmission of Sexually Transmissable Infections: A Narrative Review

Over the last few decades, behavioral changes in sexual practices have made oral transmission of traditional sexually transmissible infections increasingly recognized. Patients harboring a sexually transmissible infection may first present lesions on the oral cavity, as these may be visible and interfere with basic functions such as speech or swallowing. Moreover, the oral cavity may function as a reservoir for future spread of these infections. In order to successfully control this problem, a greater focus on oral sex should be persued, along with promotion of the use of condom and education on safe oral sex practices. Furthermore, examination of the oral cavity should is essential when evaluating any patient suspected of harboring a sexually transmissible infection. In this article, oral transmission of several viral and bacterial infections is reviewed, including human papillomavirus infection, genital herpes, syphilis and gonorrhea, among others.

Persistent Genital Arousal Disorder: Review of Pertinent Peripheral Nerves

INTRODUCTION

Persistent genital arousal disorder (PGAD) is a condition that is still poorly understood. Etiologies reported for PGAD are vascular, neurological, pharmacological, and psychological. Determining the neurophysiological etiology of PGAD began with developing an understanding of the underlying biomechanics of the pudendal nerve and the female sexual response.

AIM

To summarize the anatomy, physiology, etiologies, diagnostics, and treatments of the pertinent peripheral nerves involved in the pathology of PGAD.

METHODS

We performed a PubMed, Cochrane, Embase, Web of Science, and Google Scholar search for English-language articles in peer-reviewed journals with no predefined time period for inclusion. Terms included "humans"[All Fields] AND "persistent"[All Fields] AND/OR ("genitalia"[All Fields] OR "genital"[All Fields]) AND/OR "arousal"[All Fields] AND/OR ("disease"[All Fields] OR "disorder"[All Fields]) AND/OR "nerve"[All Fields]. The main outcomes of the papers were reviewed.

MAIN OUTCOME MEASURE

The main outcome measures were the anatomy and physiology, etiologies, history and physical examination, diagnostic imaging, and current evidence for the treatment of PGAD related to the peripheral nervous system.

RESULTS

Most of the literature for PGAD originates from case studies. The diagnosis of PGAD itself is still a debated topic of discussion. More recent data published indicate that this disease affects males, as well.

CONCLUSION

Nerve entrapment may be a source of continuous arousal. Associated PGAD symptoms would depend on the segment of the nerve involved. Unwelcomed or unwanted arousal has been observed as the most common detrimental symptom. Pelvic 3-tesla magnetic resonance imaging is recommended in all patients with suspected nerve entrapment. Lumbosacral 3-tesla magnetic resonance imaging is recommended if a Tarlov cyst or a herniated intervertebral disc is suspected. If the peripheral nerve is the source of the pathology, surgical intervention may be curative. A multidisciplinary team approach consisting of a medical provider, pelvic floor physical therapist, and sex therapist has demonstrated benefits. There are currently no Food and Drug Administration-approved evidenced-based treatments for PGAD. Klifto KM, Dellon AL. Persistent Genital Arousal Disorder: Review of Pertinent Peripheral Nerves. Sex Med Rev 2020;8:265-273.

HIV Pre-exposure Prophylaxis for People Who Inject Drugs: The Context of Co-occurring Injection- and Sexual-Related HIV Risk in the U.S. Northeast

Background: People who inject drugs (PWID) are at increased risk for HIV infection through sharing contaminated needles and injection equipment, and engaging in condomless sex. Objectives: To qualitatively examine the overlapping nature of these behaviors among PWID in the US Northeast. Methods: We recruited HIV-uninfected PWID and key informants through community-based organizations. Qualitative interviews explored sexual partnerships as they related to sharing contaminated needles and injection equipment, engaging in condomless sex, and associated indications for PrEP among PWID. Results: Among 33 PWID, 66% engaged in condomless vaginal or anal sex in the past 3 months, and 27% had three or more sexual partners in this same time period. Over half engaged in any past month distributive or receptive syringe sharing (64%). We identified three contexts through which overlapping sexual and injection-related HIV risks emerged, including (1) multiple concurrent sexual partnerships; (2) using and injecting drugs with sexual partners (including increase injecting of crystal methamphetamine); and (3) exchanging sex for money or drugs (including among male PWID). Condom use was inconsistent across these contexts. Limited interactions with healthcare providers often resulted in sexual risks being overlooked in light of competing health concerns. Conclusions: Sexual risk for HIV acquisition is complex and multi-faceted among PWID yet may be overlooked by prevention and healthcare providers. Comprehensive HIV prevention efforts must acknowledge the distinct contexts in which overlapping injection and sexual risk behaviors occur. Increased sexual health screening and risk reduction services including PrEP for PWID may help curtail transmission in this population.

Forensic Implications of the New Classification of ICD-11 Paraphilic Disorders in Brazil

INTRODUCTION

The World Health Organization (WHO) Department of Mental Health and Substance Abuse appointed a Working Group on Sexual Disorders and Sexual Health in order to revise and propose changes to ICD-10 categories.

AIM

Analyze ethical and legal implications in Brazil of the proposed ICD-11 diagnostic criteria for paraphilic disorders.

METHODS

A forensic working group of Brazilian experts in collaboration with representatives of WHO reviewed the proposed modifications to the classification of Disorders of Sexual Preference in ICD-10 (F65), which is recommended to be replaced by Paraphilic Disorders in ICD-11. Proposals were reviewed through a medicolegal lens, using a legal and policy analysis guide put forth by WHO. The premise of this review was to understand that, although the ICD classification is intended to provide a basis for clinical and statistical health interventions, medical diagnostics may also be entangled in the complex legal, normative, and political environment of various countries.

MAIN OUTCOME MEASURE

The most important proposed change to this section is to limit the concept of paraphilic disorders primarily to patterns of sexual arousal involving a focus on others who are unwilling or unable to consent, but this change has not affected the ethical and legal aspects of psychiatric functioning in the Brazil.

RESULTS

Because Brazilian criminal law is directed toward criminal behavior and not to specific psychiatric diagnoses, the changes proposed for ICD-11 are not expected to create obstacles to health services or to modify criminal sentencing.

CLINICAL IMPLICATIONS

Although ICD-11 has a number of changes in its content, there are no significant clinical implications in the Brazilian context, but a better clarity of conceptual definitions and diagnostic criteria.

STRENGTHS & LIMITATIONS

The study is conducted with people from different Brazilian states, which is important for a comprehensive view. On the other hand, considering that it is a very heterogeneous country, there is the limitation that an even wider scope of the study is not possible.

CONCLUSION

In the Brazilian context, the new guidelines for paraphilic disorders contribute to clinical utility and are not expected to create difficulties related to the legal, social, and economic consequences of sexual offenses in the country. Abdalla-Filho E, de Jesus Mari J, Diehl A, et al. Forensic Implications of the New Classification of ICD-11 Paraphilic Disorders in Brazil. J Sex Med 2019; 16:1814-1819.

Paroxetine, but not Vortioxetine, Impairs Sexual Functioning Compared With Placebo in Healthy Adults: A Randomized, Controlled Trial

INTRODUCTION

Sexual dysfunction is prevalent among patients with depression, but assessment of treatment-emergent sexual dysfunction (TESD), a common side effect of antidepressants, can be confounded by the treatment of depressive symptoms in some patients.

AIM

To evaluate sexual functioning in healthy volunteers administered vortioxetine compared with paroxetine, an antidepressant known to cause sexual dysfunction, and placebo.

METHODS

This phase 4, multicenter, randomized, double-blind, placebo-controlled, 4-arm, fixed-dose, head-to-head study compared sexual functioning in healthy volunteers administered vortioxetine (10 and 20 mg once daily [QD]), paroxetine (20 mg QD), or placebo for 5 weeks. Approximately equal numbers of men and women ages 18-40 years with normal sexual functioning (self-reported Changes in Sexual Functioning Questionnaire Short-Form [CSFQ-14] score > 47 for men; > 41 for women) were enrolled. Two modified full analysis sets adjusting for treatment non-compliance were prespecified.

MAIN OUTCOME MEASURE

The primary endpoint was change in CSFQ-14 total score for vortioxetine (10 and 20 mg) vs paroxetine after 5 weeks. Additional endpoints included CSFQ-14 change scores vs placebo, CSFQ-14 subscales, and patient global impression.

RESULTS

Of the 361 subjects enrolled (mean age, 28.4 years), approximately 57% were white, 34% black/African American, and 4% Asian. Vortioxetine 10 mg was associated with significantly less TESD than paroxetine (mean difference, +2.74 points; P = .009). Although vortioxetine 20 mg was associated with numerically less TESD than paroxetine (mean difference, +1.05 points), this difference did not reach statistical significance. Non-compliance appeared to influence results, particularly the paroxetine and vortioxetine 20 mg arms. Paroxetine, but not vortioxetine, was associated with statistically significantly more TESD vs placebo. Vortioxetine also had better outcomes than paroxetine in the 3 phases and 5 dimensions of sexual functioning measured by CSFQ-14.

CLINICAL IMPLICATIONS

These data establish that vortioxetine is associated with less TESD than paroxetine in healthy individuals, suggesting that vortioxetine may be a drug of choice in managing depressive disorders when sexual functioning is a concern.

STRENGTHS & LIMITATIONS

Conducting the study in healthy adults mitigated the risk of an underlying condition (eg, depression) confounding the results. Assay sensitivity was demonstrated by statistically significant TESD with paroxetine vs placebo. The single comparator, paroxetine, and short study duration limit the generalizability of these results.

CONCLUSION

Vortioxetine is associated with less TESD than paroxetine in healthy adults across all phases and dimensions of the sexual response cycle. Vortioxetine was not significantly different from placebo on sexual functioning; however, the difference was significant between paroxetine and placebo, validating study results. Jacobsen P, Zhong W, Nomikos G, et al. Paroxetine, but not Vortioxetine, Impairs Sexual Functioning Compared With Placebo in Healthy Adults: A Randomized, Controlled Trial. J Sex Med 2019; 16:1638-1649.